Division of Phoniatrics-Logopedics, Department of Otorhinolaryngology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.
Eur Arch Otorhinolaryngol. 2019 Oct;276(10):2849-2856. doi: 10.1007/s00405-019-05553-y. Epub 2019 Jul 16.
Laryngeal electromyography (LEMG) has been considered as gold standard in diagnostics of vocal fold movement impairment, but is still not commonly implemented in clinical routine. Since the signal interpretation of LEMG signals (LEMGs) is often a subjective and semi-quantitative matter, the goal of this study was to evaluate the inter-rater reliability of neurolaryngologists on LEMGs of volitional muscle activity.
For this study, 52 representative LEMGs of 371 LEMG datasets were selected from a multicenter registry for a blinded evaluation by 7 experienced members of the neurolaryngology working group of the European Laryngological Society (ELS). For the measurement of the observer agreement between two raters, Cohen's Kappa statistic was calculated. For the interpretation of agreements of diagnoses among the seven examiners, we used the Fleiss' Kappa statistic.
When focusing on the categories "no activity", "single fiber pattern", and "strongly decreased recruitment pattern", the inter-rater agreement varied from Cohen's Kappa values between 0.48 and 0.84, indicating moderate to near-perfect agreement between the rater pairs. Calculating with Fleiss' Kappa, a value of 0.61 showed good agreement among the seven raters. For the rating categories, the Fleiss' Kappa value ranged from 0.52 to 0.74, which also showed a good agreement.
A good inter-rater agreement between the participating neurolaryngologists was achieved in the interpretation of LEMGs. More instructional courses should be offered to broadly implement LEMG as a reliable diagnostic tool in evaluating vocal fold movement disorders in clinical routine and to develop future algorithms for therapy and computer-assisted examination.
喉肌电图（LEMG）被认为是诊断声带运动障碍的金标准，但尚未在临床常规中广泛应用。由于 LEMG 信号（LEMGs）的信号解释通常是主观和半定量的，因此本研究的目的是评估神经喉科医生对自主肌肉活动的 LEMG 的组内可靠性。
在这项研究中，从一个多中心登记处选择了 371 个 LEMG 数据集的 52 个代表性 LEMG，由欧洲喉科学会（ELS）的神经喉科工作组的 7 名经验丰富的成员进行盲法评估。为了测量两个观察者之间的观察者一致性，计算了 Cohen 的 Kappa 统计量。为了评估七位检查者之间的诊断一致性，我们使用了 Fleiss' Kappa 统计量。
当关注“无活动”、“单纤维模式”和“强烈减少募集模式”这三个类别时，组内可靠性的 Cohen's Kappa 值在 0.48 到 0.84 之间，表明评分者之间存在中度到近乎完美的一致性。用 Fleiss' Kappa 计算，七位评分者之间的一致性为 0.61，表明一致性较好。对于评分类别，Fleiss' Kappa 值在 0.52 到 0.74 之间，也显示出良好的一致性。
参与的神经喉科医生在 LEMG 的解释方面达成了良好的组内可靠性。应提供更多的指导课程，以便在临床常规中广泛应用 LEMG 作为评估声带运动障碍的可靠诊断工具，并开发用于治疗和计算机辅助检查的未来算法。
